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Baseline FDG PET/CT-Defined Axillary Burden Predicts Axillary Pathologic Complete Response After Neoadjuvant Therapy

Mehmet Tarık Tatoğlu1, İlker Nihat Ökten2, Ebru Ibisoglu3

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Predicting axillary pathologic complete response (pCR) in breast cancer patients using baseline [18F]FDG PET/CT scans is feasible. This approach may help tailor treatment by assessing nodal burden and predicting response to neoadjuvant systemic therapy (NST).

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiomics

Background:

  • Predicting axillary pathologic complete response (pCR) after neoadjuvant systemic therapy (NST) is crucial for risk-adapted axillary management in clinically node-positive breast cancer (BC).
  • Current practical baseline PET-derived predictors for axillary pCR are limited, necessitating further research into predictive markers.

Purpose of the Study:

  • To evaluate the predictive performance of baseline [18F]FDG PET/CT-defined axillary burden combined with clinical variables for predicting axillary pCR in node-positive breast cancer patients.
  • To assess the utility of PET-derived metrics in guiding risk-adapted axillary management strategies.

Main Methods:

  • A retrospective analysis of 115 clinically node-positive, M0 breast cancer patients treated with NST and surgery was conducted.
  • Two ridge-penalized logistic models were developed, integrating routine clinical variables with baseline PET-defined axillary burden (hypermetabolic ALN count or burden group).
  • Model performance was assessed using stratified 5-fold cross-validation, with AUC, Brier score, and calibration metrics evaluated via bootstrapping.

Main Results:

  • Axillary pCR was observed in 51.3% of patients (59/115).
  • Both models demonstrated good discrimination (AUC 0.80 and 0.79) and acceptable calibration.
  • Greater baseline PET-defined axillary burden was associated with lower odds of pCR, while molecular subtype and anti-HER2 therapy strongly predicted response.

Conclusions:

  • Ridge models incorporating baseline [18F]FDG PET/CT-defined axillary burden show promising internal performance for predicting axillary pCR in breast cancer.
  • These findings suggest potential for PET-derived imaging biomarkers in tailoring axillary treatment, pending external validation.